Back to Program | 2010 Program and Abstracts Overview | 2010 Posters

Introduction: Prior studies have documented increased burst strength of buttressed vs. non-buttressed linear staple lines. However, available tissue reinforcement systems require manual loading and can be time-consuming, require additional training or dislodge during stapler usage. The purpose of this study was to perform an in-vivo comparison of buttressed versus non-buttressed linear staple lines using a novel pre-loaded tissue reinforcement system; specific outcomes were intraoperative problems, bleeding, adhesion formation, and histologic tissue analysis.Methods: Laparoscopic sleeve gastrectomy and two jejunojejunostomies were performed in 8 dogs (47-67 kg) survived for 3, 7, 14, and 28 days. Buttress material consisted of a bioabsorbable, synthetic polyester (glycolide, dioxanone and trimethylene carbonate) and was fixated to the stapler cartridges during manufacturing. Buttressed and non-buttressed loads were used to create the gastric sleeve and to close the jejunal enterotomies; both types were used in each animal in an alternating fashion according to a randomized, matched pair design. Intraoperative outcomes included instrument malfunctions and bleeding. At necropsy, adhesions were scored and stapler lines were harvested with histological analysis performed by a board-certified pathologist in a blinded fashion. Standardized grading scales were used for all comparisons. Statistical analysis included Mann Whitney and Fisher Exact tests; data are reported as mean ± s.d.Results: A total of 40 staple lines were analyzed. No instrumentation malfunctions occurred and all buttressing materials remaining intact during stapling. Incidence of grossly visible bleeding was 5% for buttressed vs. 30% for non-buttressed (p=0.09); bleeding was rated as mild (no intervention) for buttressed and mild (n=5) and moderate (required intervention, n=1) for non-buttressed, with one non-buttressed staple line having staple malformation that required oversewing. At autopsy, no leaks were identified and adhesion scores (0-absent to 5-severe) were similar for buttressed (1.6 ± 0.8) and non-buttressed (1.9 ± 1.0) loads (n.s). Histological analysis identified no significant differences according to hemorrhage, inflammation , fibrous connective tissue, necrosis, and neovascularization scores. Conclusions: Although not statistically significant, a trend towards less gross bleeding and less staple malformation was identified for buttressed vs. non-buttressed staple lines. The novel pre-loaded bioabsorbable buttress system resulted in uncomplicated usage and no detrimental adhesion or histological outcomes. The use of this buttressing system may be beneficial.